Systemic Therapy for Psoriasis Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Systemic Therapy for Psoriasis. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Systemic Therapy for Psoriasis Indian Medical PG Question 1: What is the primary condition for which calcitriol is used as a treatment?
- A. Pemphigus
- B. Secondary hyperparathyroidism (Correct Answer)
- C. Lichen planus
- D. Leprosy
Systemic Therapy for Psoriasis Explanation: Secondary hyperparathyroidism
- Calcitriol is the active form of vitamin D (1,25-dihydroxyvitamin D₃), and it is crucial for regulating calcium and phosphate levels in the body [1].
- In secondary hyperparathyroidism, often seen in chronic kidney disease (CKD), the kidneys cannot convert vitamin D to its active form, leading to hypocalcemia and increased PTH secretion [1], [2].
- Calcitriol supplementation helps to increase calcium absorption from the gut and suppress the release of parathyroid hormone (PTH), thereby treating the underlying cause of secondary hyperparathyroidism [1], [2].
- This is the primary therapeutic indication for calcitriol in clinical practice.
Lichen planus
- This is a chronic inflammatory condition affecting the skin, hair, nails, and mucous membranes
- Typically treated with corticosteroids or other immunosuppressants
- Calcitriol has no primary role in the treatment of lichen planus; its therapeutic applications are predominantly related to calcium and bone metabolism
Pemphigus
- Pemphigus is a group of rare autoimmune blistering diseases that affect the skin and mucous membranes
- Primary treatment involves immunosuppressants like corticosteroids, often in high doses
- Calcitriol is not indicated for the treatment of pemphigus, as its mechanism of action is unrelated to the autoimmune processes characteristic of this disease
Leprosy
- Leprosy is a chronic infectious disease caused by the bacterium Mycobacterium leprae
- Treated with multi-drug therapy (MDT), which includes antibiotics like rifampicin, dapsone, and clofazimine
- Calcitriol is not an antibiotic and therefore has no role in treating the bacterial infection responsible for leprosy
Systemic Therapy for Psoriasis Indian Medical PG Question 2: All these drugs are known to exacerbate psoriasis, except:
- A. Beta blocker
- B. Hydroxychloroquine
- C. Ciclosporin (Correct Answer)
- D. Lithium
Systemic Therapy for Psoriasis Explanation: ***Ciclosporin***
- **Ciclosporin** is an immunosuppressant often used to **treat severe psoriasis**, not exacerbate it.
- It works by inhibiting the activation of T-cells, which are central to the pathogenesis of psoriasis.
*Beta blocker*
- **Beta-blockers**, particularly non-selective ones like **propranolol**, can worsen existing psoriasis or induce new lesions.
- The mechanism is thought to involve effects on beta-adrenergic receptors in the skin, leading to inflammation.
*Hydroxychloroquine*
- **Hydroxychloroquine**, an antimalarial and immunosuppressant, can trigger or exacerbate psoriasis, especially **pustular psoriasis**.
- It likely affects keratinocyte proliferation and immune responses in the skin.
*Lithium*
- **Lithium** is a mood stabilizer that is known to exacerbate or trigger various forms of psoriasis, including **plaque psoriasis** and **pustular psoriasis**.
- The mechanism is believed to involve alterations in cyclic AMP metabolism and arachidonic acid pathways within keratinocytes.
Systemic Therapy for Psoriasis Indian Medical PG Question 3: All of the following are used in systemic therapy of psoriasis except
- A. Methotrexate
- B. Cyclosporine
- C. Oral glucocorticoids (Correct Answer)
- D. Acitretin
Systemic Therapy for Psoriasis Explanation: ***Oral glucocorticoids***
- **Oral glucocorticoids** are generally avoided in psoriasis because they can precipitate severe **rebound flares** upon discontinuation or during dose tapering.
- While they can temporarily suppress inflammation, the risk of worsening psoriasis and other systemic side effects makes them unsuitable for long-term systemic therapy.
*Methotrexate*
- **Methotrexate** is a commonly used systemic agent for psoriasis due to its **immunosuppressive** and **anti-proliferative effects**, targeting rapidly dividing cells.
- It works by inhibiting dihydrofolate reductase and is typically given once weekly for chronic plaque psoriasis.
*Cyclosporine*
- **Cyclosporine** is an effective systemic immunosuppressant used for severe, resistant psoriasis, particularly when rapid control is needed.
- It primarily acts by inhibiting **T-cell activation** and proliferation, thereby reducing the inflammatory response in psoriasis.
*Acitretin*
- **Acitretin** is an oral retinoid derivative of vitamin A, used in severe forms of psoriasis, especially **pustular** and **erythrodermic** types.
- It works by modulating **keratinocyte differentiation** and proliferation, helping to normalize skin cell growth.
Systemic Therapy for Psoriasis Indian Medical PG Question 4: Assertion: Vitamin D analogues are effective in psoriasis. Reason: They reduce keratinocyte proliferation
- A. Both A & R true, R explains A (Correct Answer)
- B. A false R true
- C. Both A & R true, R doesn't explain A
- D. A true R false
Systemic Therapy for Psoriasis Explanation: ***Both A & R true, R explains A***
- **Vitamin D analogues** (e.g., calcipotriol) are a cornerstone treatment for psoriasis because they effectively modulate **keratinocyte proliferation** and differentiation.
- Psoriasis is characterized by the **rapid overgrowth of keratinocytes**, and the antiproliferative effects of vitamin D analogues directly address this pathological hallmark.
*A false R true*
- This option is incorrect because both the assertion (Vitamin D analogues are effective in psoriasis) and the reason (They reduce keratinocyte proliferation) are individually true.
- The effectiveness of vitamin D analogues in treating psoriasis is well-established in dermatological practice.
*Both A & R true, R doesn't explain A*
- This option is incorrect because the reduction of keratinocyte proliferation is precisely *how* vitamin D analogues exert their therapeutic effect in psoriasis.
- The mechanism of action described in the reason directly explains the efficacy mentioned in the assertion.
*A true R false*
- This option is incorrect because the reason ("They reduce keratinocyte proliferation") is a fundamental and well-understood mechanism by which vitamin D analogues work in psoriasis.
- Vitamin D analogues bind to vitamin D receptors in keratinocytes, influencing gene expression to inhibit their excessive growth.
Systemic Therapy for Psoriasis Indian Medical PG Question 5: What is the mechanism of action of Bevacizumab?
- A. Anti VEGF antibody (Correct Answer)
- B. Histone deacetylase inhibitor
- C. HER2 neu inhibitor
- D. Proteasome inhibitor
Systemic Therapy for Psoriasis Explanation: ***Anti VEGF antibody***
- **Bevacizumab** is a **monoclonal antibody** that specifically targets and binds to vascular endothelial growth factor (VEGF).
- By inhibiting VEGF, bevacizumab prevents the formation of new blood vessels (**angiogenesis**) that tumors need to grow and metastasize.
*Histone deacetylase inhibitor*
- **Histone deacetylase (HDAC) inhibitors** influence gene expression by modifying chromatin structure, leading to cell cycle arrest and apoptosis in cancer cells.
- They are used in certain hematologic malignancies and solid tumors but do not directly interfere with angiogenesis.
*Proteasome inhibitor*
- **Proteasome inhibitors** like bortezomib block the action of proteasomes, leading to an accumulation of ubiquitinated proteins and induction of apoptosis in cancer cells.
- This mechanism is distinct from blocking new blood vessel formation.
*HER2 neu inhibitor*
- **HER2 neu inhibitors** (e.g., trastuzumab) specifically target the HER2/neu receptor, which is overexpressed in certain breast and gastric cancers.
- Their action primarily involves blocking growth signals transmitted through this receptor, not inhibiting VEGF or angiogenesis.
Systemic Therapy for Psoriasis Indian Medical PG Question 6: The Drug of choice for a pregnant woman in 2nd trimester with pustular psoriasis is:
- A. Prednisolone (Correct Answer)
- B. Acitretin
- C. Methotrexate
- D. Dapsone
Systemic Therapy for Psoriasis Explanation: ***Prednisolone***
- **Systemic corticosteroids** such as prednisolone are considered **safe and effective** for treating severe pustular psoriasis during pregnancy and represent the **best option among the choices provided**.
- Pustular psoriasis is a severe systemic condition that can be associated with fever, malaise, and potential complications, necessitating **systemic therapy** rather than topical treatment alone.
- While **cyclosporine** is often considered the preferred first-line agent for severe pustular psoriasis in pregnancy in current practice, it is not listed among the options here, making prednisolone the most appropriate choice.
- Prednisolone **crosses the placenta minimally** (converted to less active prednisolone by placental 11β-HSD2 enzyme) and has a well-established safety profile in pregnancy.
*Acitretin*
- **Acitretin** is a systemic **retinoid** that is **highly teratogenic** and can cause severe birth defects including craniofacial, cardiac, thymic, and CNS abnormalities.
- It is **absolutely contraindicated in pregnancy** (FDA Category X) and must be avoided for at least 2-3 years before conception due to its long half-life and storage in adipose tissue.
*Methotrexate*
- **Methotrexate** is an **antimetabolite** and **folate antagonist** that is a potent teratogen, particularly during the first trimester.
- It can cause **aminopterin syndrome** (neural tube defects, craniofacial abnormalities, limb defects) and is **absolutely contraindicated in pregnancy** (FDA Category X).
- Women on methotrexate must use effective contraception and discontinue the drug at least 3 months before attempting conception.
*Dapsone*
- **Dapsone** has anti-inflammatory properties and is used in some dermatological conditions, but it is **not indicated for pustular psoriasis**.
- Risks in pregnancy include **hemolytic anemia** (particularly in G6PD-deficient individuals), methemoglobinemia in the newborn, and potential neonatal hyperbilirubinemia.
- It is **not a first-line or appropriate treatment** for pustular psoriasis in pregnancy.
Systemic Therapy for Psoriasis Indian Medical PG Question 7: Treatment of choice for Pustular psoriasis is:
- A. Methotrexate (Correct Answer)
- B. Psoralen - UV therapy
- C. Systemic steroid
- D. Estrogen
Systemic Therapy for Psoriasis Explanation: ***Methotrexate***
- **Methotrexate** is a systemic immunosuppressant often considered the first-line treatment for severe forms of **pustular psoriasis** due to its efficacy in reducing inflammation and hyperproliferation of skin cells.
- It works by inhibiting **dihydrofolate reductase**, thereby interfering with DNA synthesis and cell division, which is crucial in rapidly dividing cells like those found in psoriasis.
*Psoralen - UV therapy*
- **Psoralen and ultraviolet A (PUVA)** therapy can be used for chronic plaque psoriasis, but it is generally **contraindicated or used with extreme caution** in pustular psoriasis due to the risk of exacerbating the disease or causing irritation.
- **UV light therapy** can sometimes trigger or worsen pustular flares, especially in acute generalized pustular psoriasis.
*Systemic steroid*
- While systemic steroids can provide temporary relief by addressing inflammation, their use in pustular psoriasis is generally **not recommended for long-term management** due to the high risk of severe rebound flares upon withdrawal.
- Withdrawal of **systemic corticosteroids** can precipitate or worsen generalized pustular psoriasis, making them a less desirable long-term treatment option.
*Estrogen*
- **Estrogen** has no direct role in the treatment of psoriasis. Psoriasis is an inflammatory skin condition, and its pathophysiology is not directly influenced by estrogen levels.
- Hormonal therapies are not indicated for the management of psoriasis, including its pustular forms.
Systemic Therapy for Psoriasis Indian Medical PG Question 8: A patient with psoriasis was started on systemic steroids. After stopping treatment, the patient developed generalized pustules all over the body. The cause is most likely to be:
- A. Drug induced reaction
- B. Septicemia
- C. Pustular psoriasis (Correct Answer)
- D. Bacterial infections
Systemic Therapy for Psoriasis Explanation: ***Pustular psoriasis***
- The sudden withdrawal of **systemic corticosteroids** in a patient with psoriasis can trigger a severe flare-up, specifically **generalized pustular psoriasis** (GPP), characterized by widespread sterile pustules.
- GPP is a distinct, severe form of psoriasis that can be precipitated by various factors, including drug withdrawal.
*Drug induced reaction*
- While steroids themselves can have side effects, the development of **generalized pustules** shortly after stopping treatment in a known psoriasis patient points more specifically to a paradoxical worsening of their underlying disease rather than a general drug reaction.
- Drug-induced reactions are typically directly related to the drug's properties or an allergic response, whereas this scenario describes an exacerbation of the existing condition due to treatment cessation.
*Septicemia*
- Septicemia, or **sepsis**, would present with signs of systemic infection such as **fever, chills, hypotension, and organ dysfunction**, which are not explicitly mentioned as the primary cause of the pustules.
- While severe GPP can lead to systemic symptoms and potentially secondary infections, the initial development of pustules post-steroid withdrawal is a primary dermatological event, not directly caused by septicemia.
*Bacterial infections*
- **Bacterial infections** would typically manifest with purulent pustules, often with signs of inflammation, pain, and potentially fever. These pustules would contain bacteria upon Gram stain and culture.
- The pustules in **pustular psoriasis** are typically sterile, meaning they do not contain bacteria, and their appearance is a manifestation of the underlying autoimmune inflammatory process exacerbated by steroid withdrawal.
Systemic Therapy for Psoriasis Indian Medical PG Question 9: Which statement about systemic steroids in psoriasis is correct:
- A. No definitive indication exists (Correct Answer)
- B. Only as bridge therapy in rare cases
- C. Emergency situations under specialist supervision only
- D. Systemic steroids are contraindicated in all forms of psoriasis
Systemic Therapy for Psoriasis Explanation: ***No definitive indication exists***
- Systemic steroids have **no established therapeutic role** in psoriasis management and are **strongly avoided** in clinical practice.
- They can cause severe **rebound flares** upon withdrawal and may precipitate life-threatening **pustular psoriasis** or **erythrodermic psoriasis**.
- While not absolutely contraindicated in every conceivable scenario, they provide **no long-term benefit** and actively worsen disease control by masking symptoms and creating dependency.
- This statement most accurately reflects the medical consensus: systemic steroids lack definitive indications and should be avoided.
*Systemic steroids are contraindicated in all forms of psoriasis*
- While systemic steroids are strongly discouraged, the absolute term "contraindicated in **all forms**" is **too extreme**.
- There may be rare emergency situations where short-term use under specialist care is considered when safer alternatives are unavailable.
- The statement overstates the position; "no definitive indication" is more medically accurate.
*Only as bridge therapy in rare cases*
- Bridge therapy with systemic steroids is **not recommended** in psoriasis due to high risk of disease exacerbation.
- Unlike other inflammatory conditions, psoriasis responds poorly to steroid withdrawal, making bridge therapy particularly dangerous.
*Emergency situations under specialist supervision only*
- This suggests systemic steroids have a defined role in emergencies, which is **misleading**.
- Even in urgent situations, alternative treatments like **cyclosporine**, **methotrexate**, or **biologics** are strongly preferred.
- The rare exceptions don't constitute a "definitive indication."
Systemic Therapy for Psoriasis Indian Medical PG Question 10: Secukinumab is used in:
- A. Psoriasis (Correct Answer)
- B. Colorectal carcinoma
- C. Breast cancer
- D. Rheumatoid arthritis
Systemic Therapy for Psoriasis Explanation: ***Psoriasis***
- **Secukinumab** is a monoclonal antibody that targets **interleukin-17A (IL-17A)**, a cytokine crucial in the pathogenesis of psoriasis.
- It is approved for the treatment of **moderate to severe plaque psoriasis**, psoriatic arthritis, and ankylosing spondylitis.
*Colorectal carcinoma*
- **Secukinumab** is not used in the treatment of colorectal carcinoma; different classes of drugs like **chemotherapy**, **targeted therapies**, and **immunotherapy** (e.g., PD-1 inhibitors for MSI-high status) are employed.
- Colorectal cancer treatment focuses on blocking pathways specific to cancer cell growth and survival, not IL-17A.
*Breast cancer*
- **Secukinumab** has no role in the treatment of breast cancer, which is managed with therapies such as **hormonal therapy**, **chemotherapy**, **HER2-targeted therapy**, and PARP inhibitors.
- Breast cancer involves distinct molecular pathways and immune responses unrelated to IL-17A.
*Rheumatoid arthritis*
- While **rheumatoid arthritis** is an inflammatory condition, **secukinumab** is not a primary or approved treatment for it; other biologics like **TNF inhibitors**, **IL-6 inhibitors**, or **JAK inhibitors** are commonly used.
- The inflammatory cascade in rheumatoid arthritis involves different key cytokines and cellular processes compared to those targeted by secukinumab.
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